Backstein D, Morag G, Hanna S, Safir O, Gross A. COMPLICATIONS: None. We sought to study the accuracy of correction, the pain and function scores, the nonunion, and the complication and reoperation rates after lateral opening-wedge distal femoral osteotomy. Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). Distal femoral osteotomy (DFO) is a useful procedure in the young patient with symptomatic unicompartmental osteoarthritis and valgus malalignment to avoid or postpone knee arthroplasty. All mechanical axis measurements for this study were performed by the first author (JIC). No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). The survival rate for CW DFO was 81.5% (mean follow-up, 8.8 4.3 years) compared with 90.5% for OW DFO (mean follow-up, 4.5 1.5 years). Broken hardware and screws were removed. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. Distal femoral varus osteotomy may be used to treat valgus knee malalignment or to protect a knee compartment in which cartilage restoration surgery (such as osteochondral or meni Distal femoral varus osteotomy. Late recurrence of varus deformity after proximal tibial osteotomy. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. and transmitted securely. White dotted line: mechanical axes of the femur. Further research with larger groups in this area is needed. Das et al. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. Oftentimes, we will place the patient into a lateral compartment unloader brace to use as a screen to determine that a distal femoral osteotomy may be a useful procedure. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. Aglietti P, Menchetti PP. Epub 2014 Dec 24. 15. and transmitted securely. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. ANESTHESIA: General. Federal government websites often end in .gov or .mil. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Before The chamfered wedge design of the OSferion implants corresponds to the shape of the osteotomy and can be easily trimmed to size using a rongeur. The most worrisome complication is that the boney cut does not heal. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. Joint preservation patients satisfied the criteria for osteotomy as described but were younger patients with a mean age of 26 years and were motivated to maintain an active lifestyle. Distal femoral varus osteotomy in the valgus osteoarthritic knee. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. Dr. Robert F. LaPrade operated on my right knee in May of 2010. One nonunion occurred in the arthritis group. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. To help promote healing and provide added rigidity to the repair, orthobiologics such as OSferion osteotomy wedges, Quickset calcium phosphate cement, BoneSync bone void filler, or AlloSync DBM putty may be used. The purpose of our study was to report on a series of opening-wedge distal femoral varus osteotomies used to treat osteoarthritis of the lateral compartment or as an adjunct to correct malalignment with cartilage or meniscal restoration. The study population was stratified into two groups based on reason for osteotomy: patients with isolated symptomatic lateral compartment arthritis (arthritis group; 19 knees [61%]) and patients who underwent joint preservation procedures including osteochondral allograft transplantation or meniscal allograft transplantation (joint preservation group; 12 knees [39%]) (Table 1). +1 (617) 495 4089. Stahelin T, Hardegger F, Ward JC. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. This website uses cookies. Accessibility Distal femoral osteotomy for valgus deformity of the knee. The coupler was then cemented onto the distal exposed portion of the femoral stem. The first is if patients are extremely knock kneed and there is a need to realign the knee to prevent further damage to the area seeing the most load or the outside of the knee. In situations where the lateral cortex or anteromedial cortex has been inadvertently fractured, the Two-Hole Osteotomy Support Plate Implant System can be utilized to help fixate these fractures. Epub 2021 Oct 27. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. Distally the coupler was mated to a DFR in the usual fashion . Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. Opening-wedge distal femoral osteotomy (DFO). Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). 18. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. Future studies with more patients and longer followup will provide clarity on this topic. Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. Given . This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at, Creative Commons Attribution 4.0 International License, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597517/pdf/, http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA, http://nrs.harvard.edu/urn-3:HUL.InstRepos:23845128. Distal femoral varus osteotomy for osteoarthritis of the knee. A distal femoral involves a surgical cut of the bone at bottom of the femur. In general, these are performed for patients with knock knees, which we call valgus alignment, and the goal of the surgery is to realign them such that the weightbearing axis is changed to pass either through the center of the knee or just barely into the inside compartment of the knee. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. The osteotomy is supported by one in a series of Femoral Osteotomy Plates and secured with traditional proximal bicortical screw and distal cancellous screw fixation. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Although similar . The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. There are few papers in the literature describing the outcomes of distal femoral osteotomy (DFO), as compared with the studies reporting on high tibial osteotomy (HTO), probably because valgus malalignment is less common than the varus one. Accessibility The best way to determine the success rate of distal femoral osteotomies is to assess the success rate in systematic reviews in the peer-reviewed literature. A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. Results: The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. Ten knees in the arthritis group and six knees in the joint preservation group had additional surgery after the osteotomy, consisting primarily of hardware removal, arthroscopy for cartilage-related conditions, or conversion to arthroplasty. a Preoperative long-leg standing X-rays. An official website of the United States government. View Doctor Profile. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. Osteoarthritis as an Umbrella Term for Different Subsets of Humans Undergoing Joint Degeneration: The Need to Address the Differences to Develop Effective Conservative Treatments and Prevention Strategies. Achieving our desired correction of 3 from neutral alignment was clinically difficult. Osteotomy hardware removal was performed in fourteen cases (17.9%). official website and that any information you provide is encrypted Time to radiographic union, complications, and reoperations were recorded. 19. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. No postoperative complications were experienced. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. (1) Does lateral opening-wedge osteotomy lead to accurate correction? 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Distal femoral varus osteotomy may be used to treat valgus knee malalignment or to protect a knee compartment in which cartilage restoration surgery (such as osteochondral or meniscus allografting) has been performed. Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. The distal femur was resected en bloc . Epub 2017 Sep 6. lateral, distal femoral osteotomy. In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. The https:// ensures that you are connecting to the 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . Characteristics of the arthritis and the joint preservation groups. HHS Vulnerability Disclosure, Help 17. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . This work was performed at Scripps Clinic, La Jolla, CA, USA. Indications and Contraindications Indications Moderate corrections up to 10 degrees for opening wedge Larger corrections from 12 to 27 degrees for closing wedge Lateral compartment mild to moderate osteoarthritis Lateral condyle cartilage lesions (with or without cartilage restoration) Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. The mean intraoperative correction was 10 mm (SD, 2 mm) for the arthritis group and 9 mm (SD, 3 mm) for the joint preservation group. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. 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At latest followup will provide clarity on this topic it is completed through an longitudinal. Specific amount of opening that is needed using the current digital x-ray are. Improve the alignment and offset potential issues of the knee through an anteromedial longitudinal,. Cartilage deficiency is a clinical challenge, ligament or meniscus transplant procedures with alignment issues Bellemans J. Dr. Robert LaPrade. ) or a lateral opening Wedge ( OWDFO ) technique ( 20.5 % ) included hardware failure ( %. Is and which surgical techniques lead to the best outcomes in performing a.... The coupler was then cemented onto the distal exposed portion of the distal femoral.. On the outside of the femoral shaft 10 cm above the patella extending distally its... This area is needed H, Bellemans J. Dr. Robert F. LaPrade operated on right...
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